Camp Koinonia Staff Reference Form

Summer Staff 2024

Thank you for helping us hire high-quality staff. Please fill out this form to the best of your ability.

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* 1. Applicant’s Full Name

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* 2. Reference Full Name

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* 3. Reference Email

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* 4. Reference Phone Number

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* 5. Reference Employer

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* 6. Reference Job Title

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* 7. How long have you known the applicant?

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* 8. In what capacity have you known the applicant?

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* 9. Please rate the applicant on each of the following

	Excellent	Good	Fair	Poor	Don't Know
Flexibility	Flexibility Excellent	Flexibility Good	Flexibility Fair	Flexibility Poor	Flexibility Don't Know
Judgment	Judgment Excellent	Judgment Good	Judgment Fair	Judgment Poor	Judgment Don't Know
Reliability	Reliability Excellent	Reliability Good	Reliability Fair	Reliability Poor	Reliability Don't Know
Adaptable to new situations	Adaptable to new situations Excellent	Adaptable to new situations Good	Adaptable to new situations Fair	Adaptable to new situations Poor	Adaptable to new situations Don't Know
Ability to take direction	Ability to take direction Excellent	Ability to take direction Good	Ability to take direction Fair	Ability to take direction Poor	Ability to take direction Don't Know
Patience	Patience Excellent	Patience Good	Patience Fair	Patience Poor	Patience Don't Know
Ability to resolve conflict respectfully	Ability to resolve conflict respectfully Excellent	Ability to resolve conflict respectfully Good	Ability to resolve conflict respectfully Fair	Ability to resolve conflict respectfully Poor	Ability to resolve conflict respectfully Don't Know
Teamwork	Teamwork Excellent	Teamwork Good	Teamwork Fair	Teamwork Poor	Teamwork Don't Know
Leadership	Leadership Excellent	Leadership Good	Leadership Fair	Leadership Poor	Leadership Don't Know
Interpersonal Skills	Interpersonal Skills Excellent	Interpersonal Skills Good	Interpersonal Skills Fair	Interpersonal Skills Poor	Interpersonal Skills Don't Know
Enthusiasm	Enthusiasm Excellent	Enthusiasm Good	Enthusiasm Fair	Enthusiasm Poor	Enthusiasm Don't Know

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* 10. To the best of your knowledge, describe the applicant's ability to work in a stressful, fast-paced environment.

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* 11. To the best of your knowledge, describe the applicant's ability to work with children.

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* 12. To the best of your knowledge, describe the applicant's ability to work collaboratively with peers.

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* 13. (For applicants applying for a coordinator role) To the best of your knowledge, describe the applicant's ability to supervise peers.

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* 14. What are the applicant's greatest strengths?

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* 15. What are some areas for improvement?

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* 16. Are you aware of any inappropriate relationships the applicant has had with youth?

No

Yes

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* 17. Is there anything else we should know about the applicant?

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* 18. May we share the information provided in this reference with the applicant?

Yes

No

Other (please specify)